The Internet & Therapeutic Boundaries

Something is troubling me. I can’t quite work out where the boundaries lie between professionalism and the internet.

I’ve been taking a look back through my training modules, assignments and seminar notes. My Music Therapy MA training largely focused on therapeutic boundaries, confidentiality and safeguarding; the framework of being a Therapist, before we can begin to think about the musical aspect of our work. We know what we need to do to protect our patients to protect ourselves, to best work with the other care givers and professionals that are part of our patients’ care. Everything is neatly tied together with assessments, reports, clinical notes. Outcome measures. Email correspondence. Handovers.

But now I’m using the internet to discuss aspects of the music therapy profession, which is small world here in the UK, and perhaps my work. What do I need to do to ensure that me and my patients are protected from the exposure to, well, literally anyone that visits this website? And what about accurately representing the music therapy profession via this blog? What if I offend my fellow Music Therapists – my colleagues and peers? I want to be able to do the profession and clinical professionals involved justice.

Let us think first about the therapeutic boundaries we abide by in the therapy room (or in the therapy work setting):

Therapist – Patient relationship; what are the limits of our relationship? What are the boundaries? How much information will I share about myself as part of this relationship? ‘…the therapist should ask themselves how they can provide a relationship which the client may use for their personal growth’ (Rogers, C, 1967, p32)

Confidentiality; any clinical material / case studies must be anonymised unless specific consent is given. I must bear in mind that a patient or referrer / carer / parent may read this blog.

Safeguarding; to always abide by the guidelines set by the institution or local government for responding to disclosures from the patient and also to protect their welfare under your care as a Therapist

Professional issues; regular supervision: ‘Supervision is a useful tool and important processing time for therapists to go over parts of sessions that were difficult or confusing in meaning and is a time used for reflecting and processing the events, unravelling the meaning rather than jumping to conclusions’ (Mollon, P, 1997), Therapist self-care, CPD (continuing professional development).

So taking into account all of the above, how does do these elements of clinical professional practice relate to online professional practice? How can we ensure we respect our clinical boundaries when using the internet to discuss, reflect on and promote our practice? I have some initial thoughts on this, but intend to write much more detailed and reflective articles in the coming months:

The Internet & Therapist-Patient Relationship; we must consider that our patients, their referrers, carers, parents, peers etc. may have access to things that we write, publish and post online. With this in mind, I find it important to exercise the same approach towards boundaries and the limits of a Therapist-Patient relationship when I am using the internet in my professional capacity. In his 2007 article, ‘” Why can’t we be friends?”…’, Neil Foster writes that the patients’ perspective of the relationship with his or her Therapist is the most important thing to consider (Foster, N, 2007, p19-21); whilst writing this I am thinking of my patients and how they might feel about their Therapist writing a blog and writing about my relationship with them also being my job, a clinical relationship with limits that are not the usual limits in a human, social relationship.

The Internet & Confidentiality; it is imperative that no matter how we refer to our patients, reflect on aspects of our work or use a patient in a case study – no matter how this is published or discussed – their anonymity is the primary concern. This means using an alias, or assigning them a new set of initials, and changing any details which may be identifiable e.g. age, institution. On the internet it may be possible for people to ‘dig’ and find out more information from other sources which enables them to put together clues as to the places a Therapist visits, the patients we work with, and so perhaps in extreme cases – or to exercise extreme caution – we should change every detail that could make someone identifiable in any way.

The Internet & Data protection; this is an issue that I initially thought may be null and void on the internet; ‘what data am I collecting, storing and protecting?’ I thought. With further thought, I realise that this blog and website is actually a collection of resources, with data designed to be interesting, useful and relevant to others. This makes this website, and all other websites, a source of data that is public and accessible to anyone with an internet connection. Therefore, I suggest that measures are taken to ensure protection (as much as possible) from the risk of hacking, spam and other nasty things that happen on the internet (how might we deal with trolling?).

The Internet & Health & Safety; perhaps this isn’t so relevant to a website, and Music Therapist professionals using the internet to write about Music Therapy? But one term does stand out: ‘personal limits’. And maybe this means knowing our limits in creating, maintaining and publicising our online material?

The Internet & Safeguarding; just as the therapy space is one in which our patients share personal information, so is the internet. And this means that guidelines surrounding safeguarding still apply to any professional material published online, and perhaps even in response to a Music Therapist using the internet in their professional capacity. I feel that is important that the same measures are taken whether it be in the institution, a patient’s home or on the internet, if there are any concerns surrounding safeguarding, using the same protocol as the local government body or county council details. This information is accessible online; for example, Buckinghamshire Safeguarding Policy is here: http://www.bucks-lscb.org.uk/bscb-procedures/local/.

The Internet & Professional Issues; if we are using the internet in a professional capacity, should we also seek regular supervision for it? If supervision is beneficial for unravelling sessional content, perhaps writing about the music therapy profession reflectively via a blog, website or social platform aids supervision (if used appropriately and in line with above topics)? Perhaps this also ties into reflective practice? I’m wondering if it would be okay to take a professional issue arising on the internet or via use of the internet into clinical supervision. This ties largely into self-care as a Music Therapist; what coping mechanisms and support systems do we have in place online that would help us take care of ourselves? Maybe this Blog will provide some kind of outlet for me and provide a useful, reassuring resource for other Music Therapists? It would be fantastic to see more of an online community of Music Therapists in the UK; it seems that gradually we’re using Twitter more, and the BAMT forums, but it would be great to create an online community for Music Therapists. Lastly under this section; CPD is required of all Music Therapists working in the UK, and use of the internet and taking part in discussions, reading articles and publishing them too counts towards our CPD log.

The Internet & Sessional aspects; as with what happens in a Music Therapy session, I would argue that the same rules should be applied to using the internet in a professional capacity. This Blog, for example, should be consistent and reliable, and the privacy of sessions, and more importantly patients, should be protected when reflecting on sessional or professional issues online.

One questions remains:

How do personal social media accounts relate to the above?

I believe it’s unrealistic to expect people to create different professional accounts and personal accounts, for example a Music Therapist page and a personal page on Facebook or Twitter, as it’s simply too time consuming for most of us to manage. I have found that I use Twitter purely for professional purposes and Facebook for personal purposes. I have set myself a strict boundary on Facebook: I will not be friends with colleagues, patients, carers or anyone that I am involved with in a professional capacity (apart from two individuals that I made an exception for!). Am I being too boundaried and strict? I once had a potential client try to add me on Facebook to discuss Music Therapy for her child, and I felt extremely uncomfortable when trying to deal with it. Is there a right way to deal with this? And privacy settings; how much of your profile do you want people to see if they search for you?

One final thought; how can we use our personal social media accounts appropriately when talking about our profession…is it important that we are appropriate? ­What are the do’s and don’ts?

Ellie received her MA in Music Therapy from Roehampton University, and undertook additional training to receive certification as a Neurologic Music Therapist. She is employed by Chiltern Music Therapy and as well as a clinician works as a Supervisor and Manager for the organisation. Ellie has experience of working individually and running groups with adults, older adults, children and infants across a number of health and social care sectors, including learning disabilities, ASD, mental health, brain injury and dementia. Alongside her music therapy work Ellie was previously a Trustee and the Student Liaison Officer for the British Association for Music Therapy.

Great post, Ellie.
I notice the thing about keeping records for 7 years, and I wonder how that dovetails with the advice I got from the data protection service that told me to destroy everything as soon as I finished working with a client. Seems there are a lot of areas that have no one right answer.
I certainly wouldn’t allow a person to add me as a facebook friend in order to ‘discuss’ anything professional – what do these people think email is for? Waves CIC has a professional facebook page, and that works, to share interesting articles, news on funding and so on. Facebook is extraordinarily useful as a tool for connection. And, possibly extraordinarily dangerous.